Rationale and foundation of the MSNA Sudan is currently experiencing a combination of political uncertainty, economic fragility, poor service provision, continued civil conflict and vulnerability to flooding and other natural disasters. According to the 2021 Sudan Humanitarian Needs Overview (HNO), 13.4 million people (29% of the population) are in need of humanitarian assistance, an increase of 4.1 million people over 2020.3 Sudan’s Integrated Food Security Phase Classification (IPC) “Acute Food Insecurity Projection Update” (October-December 2020) indicated that almost 7.1 million people, or 16% of the population, were experiencing high levels of acute food insecurity (IPC Phase 3 or above). Prior to that, Sudan’s pre-harvest-season June-December 2020 IPC snapshot reported that 9.6 million people, or 21% of the population, were experiencing high levels of acute food insecurity, which at the time represented the highest IPC figure for Sudan on record. Alongside these economic and food security challenges, Sudan – like most countries – is battling an outbreak of Corona Virus Disease 2019 (COVID-19). The first confirmed case of the virus was reported in Sudan on 12 March 2020, and as of 1 March 2021, there had been 28,505 confirmed cases and 1,892 deaths. This outbreak occurred in the context of Sudan’s chronically under-funded basic services, including healthcare and Water, Sanitation and Hygiene (WASH).In addition, in 2020, Sudan experienced record-breaking floods that claimed the lives of 150 people and affected over 875,000 more.
In the context of these challenges, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), in conjunction with REACH and the Sudan humanitarian community decided to conduct the first annual Multi-Sector Needs Assessment (MSNA) for Sudan in 2020. This assessment was intended to support the 2021 HNO and Humanitarian Response Plan (HRP), while addressing the lack of reliable and up-to-date data on humanitarian conditions for humanitarian planning and decision-making processes, a gap that especially affected parts of the country that historically have seen less presence of aid actors.9 This MSNA was conducted in close cooperation with the Inter-Sector Coordination Group (ISCG) and the National Assessment Task Team (NATT). The International Organisation for Migration (IOM), with the assistance of 26 other partners, conducted the data collection.
The MSNA was designed, jointly with OCHA and the ISCG, as a multi-sectoral, mixed-methods assessment, whose scope was as follows:
Geographic scope: All 18 states (185 localities10 in total), plus the Abyei area.
Population groups: Non-displaced, internally displaced person (IDP) and refugee households.
Sectors: Food Security and Livelihoods (FSL); Health; Nutrition; WASH; Emergency Shelter and Non-food Items (SNFI); Protection; and Education.
The assessment included a structured household survey, which covered 13,769 households in 18 states and 165 localities, plus the Abyei area, and 196 area of knowledge (AoK) key informant interviews (KIIs) providing qualitative information on 9 states and 42 localities. Non-probability sampling strategies were used; therefore, findings cannot be generalised to the overall population of interest with a known level of precision. Data collection for the household survey ran from 16 August to 27 October 2020, and AoK KIIs took place from 28 October to 16 November 2020.
Due to limitations in partner availability and capacity, the final household-level dataset covered 162 out of 186 nondisplaced strata, 22 out of 52 IDP strata, and 22 out of 84 refugee strata. This report will focus therefore on findings for non-displaced households, with limited findings for IDP and refugee households presented separately, in a dedicated chapter, due to lower coverage of these two population groups; findings for households residing in the Abyei area will also be presented separately, due to the special administrative status accorded to this geographic entity.
MSNA results show that 92% of non-displaced households had multi-sectoral needs, at the national level and without any significant geographical differences found between different states. More than half of households (67%) had severe multi-sector needs (MSNI score of 3), while 17% had extreme multi-sectoral needs (MSNI score of 4). Further, a majority of households had unmet needs in two sectors or more, simultaneously; this means that the large majority of non-displaced households were not able to meet their basic needs in two or more of the sectors covered by this assessment.
Overall, health and Emergency Shelter and Non-Food Item (SNFI) were found to be the most common drivers of needs, with 62% and 61% of households having unmet needs in these two sectors, respectively. At the state level, a majority of households (over 50%) had unmet health and SNFI needs in nearly all states, pointing towards the existence of country-wide, structural barriers limiting the ability of households to meet their needs in these specific sectors. The combination of health and SNFI needs was also found to be the most common need profile of households (7% of households). Interviews with key informants indicate that a majority of the population was considered to be living in shelters that did not meet technical and performance standards, as defined by the SNFI sector. Further, it appears that the high cost of medicine and medical services, as well as a lack of medicine and health professionals at facilities, were significant barriers to households accessing healthcare. Health was also the most commonly self-reported priority need in Sudan (57% of all households, across all assessed population groups), in line with MSNA analysis results.
East Darfur and North Darfur had the highest proportions of households with extreme multi-sectoral needs, at 41% and 42% of all non-displaced households, respectively. Further, the percentage of households with unmet needs in any one sector was higher, for a number of sectors, in the Darfur states and in Blue Nile, compared to other states; households were thus more likely to have unmet needs in three or more sectors, simultaneously, in these states. For instance, over 70% of households had an unmet need in the health sector in North, South and West Darfur, and Blue Nile states, compared to 62% at the national level; over 75% of households had unmet SNFI needs in North, East and West Darfur, compared to 61% at the national level. This can be explained, notably, by the security context of these areas, where recurrent displacement and protection crises can be dated to as far back as the early 2000s, resulting in significant strain on services and resources and difficult access for humanitarian partners.
Notable exception to this pattern was the WASH sector. In fact, a majority of households (64%) had unmet needs in this sector in Red Sea state, as well as South Darfur state. This figure was the highest observed across all states and significantly higher than the 37% observed at the national level. The dry climate, a lack of sufficient water, poor hygiene practices, as well as flood-related damage occurred in 2020, partly explain the significant WASH gaps in Red Sea state.This highlights how significant needs exist outside of areas that are typically considered as being in a state of emergency.
At the national level, over half of non-displaced households (57%) were found to have at least one preexisting vulnerability, as defined in this analysis (female- or child- headed household; age dependency ratio19 above the national average); among these, 94% had multi-sectoral needs. While the prevalence and severity of needs did not significantly vary between households depending on their vulnerability profile, differences were found in terms of the main drivers of need. Notably, unmet needs in the Education sector were more prevalent (30% of households) among households with an age dependency ratio (ADR) above the national average, compared to those whose ADR was below the national average (10% households). Further, a higher proportion of female- or child-headed households had unmet FSL needs (45% of households), compared to households headed by an adult male (34% of households). Different need profiles were therefore associated to different vulnerability profiles.
Similar to Sudan, in the Abyei area nearly all non-displaced households (98%) had multi-sectoral needs.
Nearly half of these (47%) were found to have extreme needs (MSNI score of 4). The high prevalence of multisectoral needs, as well as their severity, hints at a concerning humanitarian situation in Abyei, overall. It is also worth noting that an overwhelming majority of households had needs in several sectors concurrently - 94% of households had needs in three or more sectors. The main drivers of multi-sectoral needs were SNFI and WASH, with over two thirds of households (82% and 73%, respectively) having unmet needs in these two sectors.
The most common need profile among households was a combination of unmet needs in these two sectors and health, simultaneously (13% of households overall). Issues with shelter enclosures, a lack of access to improved sanitation facilities, and the high cost of health services and medicine were the most common issues underlying these drivers.
Finally, all IDP and refugee households were found to have unmet needs in at least one sector, with more than half of IDP households (59%) and about one third (27%) of refugee households having extreme multisectoral needs (MSNI score of 4). Further, a majority of households among both population groups had unmet needs in three or more sectors, simultaneously. The displacement context, size of displacement caseloads, as well as the existing barriers to the delivery of aid can partly explain the high proportion of households with multi-sectoral needs for these two population groups. For both groups, SNFI was the most common driver of needs; in fact, nearly all IDP households (92%) and refugee households (96%) had unmet needs in this sector. It is worth noting that the food security situation of both IDPs and refugees appeared problematic; more than two thirds of IDP households (78%) and more than half of refugee households (65%) had unmet FSL needs.
In conclusion, according to the findings of this first MSNA, humanitarian needs in Sudan are prevalent across all states. Although humanitarian programming has historically been concentrated in specific areas of Sudan, especially in states along the border with South Sudan, MSNA findings suggest that high levels of humanitarian needs are in fact widespread across the country for some sectors, notably health and SNFI. This said, combination of multiple sectoral needs for any given household, and extreme multi-sectoral needs (MSNI score of 4) do appear concentrated in some areas over others, notably areas traditionally affected by insecurity and displacement crises, and for IDPs and refugees more so than for non-displaced populations. This top-level finding is broadly consistent with the findings of other analytical exercises, such as the IPC and the 2021 HNO. Further assessments will be needed to bridge remaining information gaps in some key areas, and further refine the understanding of needs across the country and across different population groups.